LIFESTYLE AND WELLNESS: EMOTIONAL WELLBEING AND MENTAL HEALTH/BURNOUT


jumped to 50% within 4 years, and in the class of 2012, more than half (55%) had dropped their AAEP membership within 4 years of graduation. Addi- tionally, when interviewed, 21% of graduates from the classes of 2012–2016 who are still in the equine sector reported that they would like to leave equine practice.3 As large-animal, equine, and mixed- animal practice owners can attest, it is becoming extremely difficult to hire or retain associate veter- inarians willing to work in large-animal or mixed- animal practice in the current employment market, yet many veterinarians entered veterinary school expressing a desire to become large-animal or equine veterinarians.4 Why are veterinarians leaving large-animal prac-


tice or unwilling to practice it at all? When this question is asked, two key reasons are commonly given: financial stress and the lifestyle associated with equine practice.3 New equine practitioners, on average, have a lower starting salary than all other new practitioners.3 The average starting sal- ary for new equine associates in the 2016 survey was roughly $45,000. In comparison, the average start- ing salary for similar graduates who were hired into companion animal exclusive positions was $76,000. Additionally, a large number of equine graduates reported performing an internship compared to com- panion animal veterinarians. The average re- ported salary for equine internships was $26,000. Due to the economic crisis that started in 2006, the horse population in the United States declined by 33% between 2006 and 2012.4 Equine veterinari- ans saw their average income decrease by 6.7% dur- ing that time period. In contrast, companion animal-exclusive practitioners saw average income increase by 22.7% during the same period of time. When faced with the option to work less hours and make more money in small-animal medicine, the choice to leave equine practice is clear for many equine veterinarians. To compound this financial motivation, veterinary


school tuitions in the United States have tripled between 1999 and 2016,4 and student loan interest rates are much higher than they were 15–20 years ago. Veterinary salaries, however, have not in- creased in correlation to this increased cost of education. Large-animal veterinarians have the lowest reported mean incomes compared to other sectors of veterinary medicine.4 Veterinarians are now graduating with more debt than ever before and are often accumulating interest on their loans faster than they can repay it.4 The cost of 4 years of veterinary education and living expenses is esti- mated at $127,138 to $363,974 depending on school attended, with an average cost of $189,912. The average reported debt incurred during vet school was $141,000 in 2016, with around 5% of graduates having more than $300,000 in debt accrued during veterinary school. Of great concern is that due to increased costs and lack of increased salaries, the debt to income ratio is greater than 2:1 for more


416 2019  Vol. 65  AAEP PROCEEDINGS


than half of all graduates of veterinary schools.4 (The reported goal of the AVMA is to reduce this debt to income number to 1.4:1.) This financial pres- sure makes it challenging for new graduates to accept lower-paying positions in large-animal or equine practices, knowing that they will struggle to pay their loans back, even if they truly have a pas- sion for large-animal or equine practice. In the past, when loan debts and interest rates were lower, it was more feasible for veterinarians to take lower- paying positions in large animal to pursue their “passion.” In addition to the financial aspects, another issue


that is frequently cited as a reason for veterinarians feeling burnt out and leaving large-animal medicine are the long hours and need to be on call for after- hours emergencies. Large-animal veterinarians traditionally work more hours and more unpredict- able schedules compared to small-animal veterinar- ians.4 As a nature of the practice, large-animal veterinarians tend to see more emergencies and work more weekends, holidays, and after-hours calls than most small-animal veterinarians. Being available for emergencies is an unavoidable require- ment for most large-animal and equine veterinari- ans, but this requirement can cause significant hardship for family life and any personal plans or hobbies outside of work. There is rarely an “emer- gency clinic” to refer patients to after-hours as there is in small-animal medicine. Additionally, large- animal clients not only expect after-hours emer- gency services but often require the veterinarian to perform mobile field calls to their home or farm. Some states even require veterinarians to provide emergency coverage for their clients or have a signed referral agreement with another clinic will- ing to take their emergencies,5 which is not always a convenient option for rural practitioners without a nearby referral hospital. For the solo practitioner, this sense of obligation to be on call all the time can be stressful, exhausting, frustrating, and is a major factor when veterinarians choose to leave the pro- fession to work in a small-animal practice with no after-hours requirements. Larger practices often share on call among several veterinarians, and sometimes even interns. However, the solo practi- tioner and veterinarians in small practices can eas- ily become overwhelmed when they feel obligated to be on call every day. When new graduates are look- ing for jobs, a common complaint to employers about why they don’t want to work large animal is that they don’t want to be on call for emergencies. This negative perception of being on call is worsened if the veterinarian previously had to work in a practice where they were on call a large portion of the time, such as a small practice or internship. The financial pressures associated with large-


animal practice, as well as being on call seem to be the biggest and most common reasons for veterinar- ians to leave large-animal practice; however, there are several other factors that may also contribute to


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